Health profiles of First Nations children living on-reserve in Northern Ontario: a pooled analysis of survey data

Community-based screening and triage connecting First Nations children and youth to local supports: a cross-sectional study

BACKGROUND

First Nations children in Canada experience health inequities. We aimed to determine whether a self-report health app identified children's needs for support earlier in their illness than would typically occur.

METHODS

Children (aged 8 to 18 yr) were recruited from a rural First Nation community. Children completed the Aaniish Naa Gegii: the Children's Health and Well-being Measure (ACHWM) and then met with a local mental health worker who determined their risk status. ACHWM Emotional Quadrant Scores (EQS) were compared between 3 groups of children: healthy peers (HP) who were not at risk, those with newly identified needs (NIN) who were at risk and not previously identified, and a typical treatment (TT) group who were at risk and already receiving support.

RESULTS

We included 227 children (57.1% girls), and the mean age was 12.9 (standard deviation [SD] 2.9) years. The 134 children in the HP group had a mean EQS of 80.1 (SD 11.25), the 35 children in the NIN group had a mean EQS of 67.2 (SD 13.27) and the 58 children in the TT group had a mean EQS of 66.2 (SD 16.30). The HP group had significantly better EQS than the NIN and TT groups (p < 0.001). The EQS did not differ between the NIN and TT groups (p = 0.8).

INTERPRETATION

The ACHWM screening process identified needs for support among 35 children, and the associated triage process connected them to local services; the similarity of EQS in the NIN and TT groups highlights the value of community screening to optimize access to services. Future research will examine the impact of this process over the subsequent year in these groups.

Rasch Measurement Theory's contribution to the psychometric properties of a co-created measure of health and wellness for Indigenous children and youth

OBJECTIVES

To determine how Rasch Measurement Theory (RMT) methods can be used to assess the psychometric properties of the Aaniish Naa Gegii: the Children's Health and Wellbeing Measure (ACHWM) and Qanuippit.

STUDY DESIGN AND SETTING

Indigenous children aged 8-18 years, from five communities, completed the 62-item ACHWM. We applied RMT methods to ACHWM data from 401 children (mean age 13.4 ± 3.4 years; 51% male) from across Ontario to examine how well the items captured the full range (±3 logit) of the concept of interest in each domain, targeted the needs of Indigenous children, and met the criteria for unidimensional and invariant measurement.

RESULTS

RMT results indicated moderate-fit overall fit (raw χ² = 809, P < 0.001). This model was further improved by aggregating the five response categories into three categories. All four domains showed excellent overall fit to the Rasch model (P > 0.05), with items covering between -4.51 and 6.02 logit, with no gaps along the theoretical continua.

CONCLUSION

This study provides evidence that a set of conceptually derived items was able to produce a measure that fits the Rasch model. These results aid our understanding of wellness by establishing the clinical meaning of the scale scores.